중소병원 적정성 평가 개선방안

Abstract

Quality assessment has been launched for hospitals from 2019 by Health Insurance Review and Assessment Agency (HIRA). The assessment includes indexes for doctors, nurses, beds, visitor management, infection control, and patient safety which can be applied to all hospitals. However, the assessment does not deal with doctors’ practices. This study was conducted to develop the new assessment plan for hospital quality. We reviewed the overall areas of quality assessment by HIRA including the first quality assessment for hospitals. In additions, some strategies for quality assessment in health care from USA, Australia and Canada were summarized including quality indicators. Also, we checked other quality measures which were used for various objectives in health care in Korea. We found the levels of quality in hospitals were relative lower than the levels in general or tertiary teaching hospitals. In addition, the areas of quality assessment has focused on the field with high mortality and costly issues which are not relevant with hospitals. Osteopedics, psychiatry, obstetrics, pediatrics, rehabilitation are main departments for hospitals. Therefore, we tried to find quality indicators on these areas. Moreover, quality assessment areas were checked which have dealt with hospitals such as hypertension, homodialysis, and so on. Efficiency indicators such as length of stay and national spending were also considered for new indicators. Finally, the new quality assessment plan for hospital have developed including common indicators which were used in the first assessment and newly developed. In addition, specific indicators were also included in this plan which were used previous quality assessment such as hypertension, homodialysis and so on and new indicators for healthcare delivery system, knee and hip replacement, vertebral surgery, rehabilitation, obstetrics, colorectal and anal surgery. We also suggests patient reported outcome indicators in the near future. This system adopted absolute evaluation system and financial and non-financial support like a pay for report and pay for performance. We hope that this system will be helpful to improve quality in healthcare for hospital.